Sublingual immunotherapy (SLIT) review: effective, with no reported anaphylaxis or epinephrine use

Allergen immunotherapy was introduced by Leonard Noon 100 years ago and is the only disease-modifying treatment for allergic individuals (Allergy, 2012). Allergic rhinitis is common worldwide, with significant morbidity and impact on quality of life. In patients who don’t respond adequately to anti-allergic drugs, subcutaneous allergen immunotherapy (SCIT) is effective but requires specialist administration.

Sublingual immunotherapy (SLIT) may represent an effective and safer alternative, according to the review authors. I would add that SLIT requires specialist prescription and monitoring as well (by an allergist/immunologist).

This Cochrane systematic review is an update of one published in 2003, and included 49 randomised, double-blind, placebo- controlled trials of sublingual immunotherapy in adults and children.

There were significant reductions in symptoms (standardised mean difference (SMD), −0.49; P less than 0.00001) and medication requirements (SMD −0.32) compared with placebo.

None of the trials reported severe systemic reactions, anaphylaxis or use of adrenaline (epinephrine). The authors concluded that sublingual immunotherapy (SLIT) is effective for allergic rhinitis and appears a safe route of administration.

References:
Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT). Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02583.x.

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